The method of treatment of hydrocephalus

 

(57) Abstract:

The invention relates to medicine, namely to neurosurgery. Impose Presevo hole in the projection of the occipital horn of the lateral ventricle, the Central end of the drainage system installed in the lateral ventricle of the brain. Produce the fixation of the valve over resevil hole podporujici. Gradually, segmental, using Windows Explorer peripheral end of the drainage system is conducted to the ear region, the posterior edge of the Sterno sternocleidomastoid muscle, srednechrochnoy line on the front surface of the chest, under the skin. After applying carboxymaltose and apariencia below the navel 2 cm along the midline introduce the laparoscope. By palpation of the anterior abdominal wall defining the projection of the round ligament of the liver. Make a skin incision along the diameter of trocar length of 3.5 mm and promote wound peripheral end of the drainage system. Trocar under visual control of the laparoscope is carried out in the round ligament of the liver, i.e., form a channel for holding the peripheral end of the drainage system in the round ligament of the liver and install peripheral end of the drainage system are superimposed skin stitches on the wound. The method allows Rrectio hydrocephalus.

A known method of surgical treatment of hydrocephalus using special drainage systems, which are aimed at removing excessive accumulation of cerebral spinal fluid (CSF). The liquor is drained into the right atrium, pleural cavity, the thoracic duct, the abdominal cavity. The most common ventriculoperitoneal shunting (Pudenz, R. H.// J. Neurosurg.-1966.-vol.25.-P. 602-608).

The purpose of ventriculoperitoneal shunt - formation of an anastomosis between the lateral ventricle of the brain and the abdominal cavity. Overprint prezioso holes in the projection of the occipital horns (so Dandy). In the lateral ventricle of the brain is implanted Central end of the drainage system. The valve is fixed to the soft tissues over resevil hole podporujici. Gradually, segmental, using Windows Explorer peripheral end of the drainage system held to the ear region, the posterior edge of the Sterno sternocleidomastoid muscle, srednechrochnoy line on the anterior surface of the thorax on the left in paraumbilical the area under the skin. Adrectal, paramedian or midline incision exposing the peritoneum, which is immersed peripheral end of the drainage. Often used minilap trocar.

In both cases, the position of the catheter in the abdominal cavity is uncontrolled, resulting in the development of the so-called peritoneal pancreatic pseudocyst (limited by the peritoneum cavity containing the peritoneal catheter and the fluid), the frequency of which is 1-3,4% (Khachatryan C. A., Bersnev B. N. Hydrocephalus, 1998)

This resorption of the cerebrospinal fluid in the abdominal cavity is disturbed, leading to an increase in pressure in the pancreatic pseudocyst, the formation of a positive pressure gradient in the abdominal cavity and, consequently, dysfunction of the shunt.

Other complications include: development of mechanical intestinal obstruction due to entanglement of the catheter around the ulcer, perforation of the intestine, bladder, uterus. This is due to the uncontrolled migration of peripheral end of the drainage system in response to a change in body position due to active peristalsis of the bowel.

The technical result of the invention is the prevention of complications in the abdominal cavity after ventriculoperitoneal shunt.

The technical result is achieved in that the peripheral end of the drainage system is installed endoscopically in the round ligament of the liver, p the way: is superimposed Presevo hole in the projection of the occipital horns (dot Dandy), the Central end of the special drainage system is installed in a lateral ventricle of the brain. Is fixed valve over resevil hole podporujici. Gradually, segmental, using Windows Explorer peripheral end of the drainage system held to the ear region, the posterior edge of the Sterno sternocleidomastoid muscle, srednechrochnoy line on the front surface of the chest, under the skin.

After applying carboxymaltose and apariencia below the navel 2 cm along the midline laparoscope is introduced. By palpation of the anterior abdominal wall is determined by the projection of the round ligament of the liver. Produce a skin incision along the diameter of trocar length of 3.5 mm and displaying in the wound peripheral end of the drainage system. Trocar under visual control of the laparoscope carry out in the round ligament of the liver, i.e., form a channel for holding the peripheral end of the drainage system in the round ligament of the liver. Set the peripheral end of the drainage system in the round ligament of the liver.

According to Melekhov, P. A., Mitina S. E., Kuleshov A. N. (Annals of surgery. Grekov, 1983, No. 2, pp. 45-47), on the basis of anatomical studies found that the round ligament of the liver can biposto occlusive hydrocephalus, due to the tumor Parasitology localization. Produced imposition prezioso holes in the area of the projection of the occipital horns (so Dandy), set the peripheral end of the drainage system into the right lateral ventricle of the brain. Gradually, segmental, using Windows Explorer peripheral end of the drainage system held to the ear region, the posterior edge of the Sterno sternocleidomastoid muscle, srednechrochnoy line on the front surface of the chest, under the skin. After applying carboxymaltose and apariencia below the navel 2 cm along the midline entered the laparoscope. By palpation of the anterior abdominal wall defined by the projection of the round ligament of the liver. Produced skin incision length 3 mm, wound output peripheral end of the drainage system. Trocar under visual control of the laparoscope carry out in the round ligament of the liver in the clearance of its installed peripheral end of the drainage system. Trocar removed. Skin sutures were removed on the 5th day. Wound healing by primary intention. Hypertension-hydrocephalic syndrome regressed.

After 10 days on the background of a functioning shunt generated by ultrasonic tomography of the abdominal cavity, while in the lumen of the round svazku system.

Viewed through the year. Performed a control ultrasonic tomography of the abdominal cavity in the projection of the round ligament of the liver has a cavity former size, containing liquid and the end of the tube draining the system.

According to the described method operated on 12 patients. The follow-up period ranging from 3 months to 1 year.

Occlusion of the Central and peripheral ends of the drainage system during the observation period is not marked.

Gipertenziah and intraabdominal complications also were observed. Compared with the prototype of the proposed method of drainage in the round ligament of the liver can reduce the number of complications associated with the formation of peritoneal pseudocyst, migration peripheral end of the drainage system with damage to the organs of the abdomen and pelvis.

The method of treatment of hydrocephalus by establishing a Central end of the drainage system in the lateral ventricle of the brain, holding it under the skin and the introduction of the peripheral end of the drainage system in the abdominal cavity, characterized in that the peripheral end of the drainage system under the control of the laparoscope was introduced into the round ligament of the liver.

 

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